Registered Nurse - Care Coordinator - Care Management

Parkland Health

8d•Onsite

About The Position

Establishes and maintains an efficient, cost-effective care management process by determining patients’ financial and medical eligibility and medical necessity, and by developing, implementing, and monitoring individual patient plans of care. Communicates those plans to patients, families, and Parkland staff to support quality patient care throughout the healthcare continuum and compliance with program and Parkland policies and procedures. Maintains knowledge and skills related to utilization review, care coordination, performance improvement, and professional licensure and certification. This is a full-time, onsite position with a daytime schedule, Monday through Friday, working an eight-hour shift from 7:30 a.m. to 4:00 p.m.

Requirements

Graduate of an accredited school of Nursing.
At least two years of hospital or community-based patient care nursing experience; experience in the assigned clinical area is preferred.
Current, valid RN license or temporary RN license from the Texas Board of Nursing, or a valid Compact RN license.
Current healthcare provider BLS for Healthcare Providers certification from the American Heart Association, American Red Cross, or Military Training Network.
Provide care in accordance with the Texas Nursing Practice Act, established protocols, multidisciplinary plans of care, and clinical-area standards.
Ability to communicate and collaborate effectively with diverse patients, families, and healthcare staff.
Working knowledge of specific patient populations and the disease processes affecting them.
Working knowledge of PC operations and word processing software in a Windows environment.
Working knowledge of laws and regulations governing Medicare, Medicaid, and community-based funding sources.
Self-directed, with the ability to prioritize and solve problems.
Ability to demonstrate patient-centered and patient-valued behaviors.

Nice To Haves

Hospital or community-based patient care nursing experience in the assigned clinical area.

Responsibilities

Assess patients on the assigned Care Coordination team and develop case management plans of care using information from patients, physicians, and other relevant healthcare team members.
Determine patient funding sources and potential eligibility when appropriate.
Develop objectives, goals, and actions to address needs identified through assessment.
Use hospital-approved review criteria to ensure appropriate bed status; identify at-risk populations using approved screening tools; follow reporting procedures; and ensure appropriate admission status is documented.
Collaborate with the multidisciplinary team and patient to implement the plan of care, monitor progress, and intervene as needed to support patient-focused, high-quality, efficient, and cost-effective services.
Communicate financial counseling information as appropriate and resolve system barriers affecting diagnostic or treatment progress.
Identify and resolve discharge delays and obstacles; maintain agreement on the plan of care among the patient or family, physician, and payer.
Advocate for patients to secure coverage for needed community services and coordinate resources to support transitions to the appropriate next level of care.
Communicate and update the plan of care with patients and families, reassess its effectiveness, complete care coordination documentation, and work with nursing and other disciplines to meet discharge needs, including teaching.
Collaborate with the healthcare team to identify best practices for patient outcomes and develop mechanisms for reporting outcomes to physicians and other team members.
Perform utilization management for assigned patients by applying approved criteria to monitor admission and continued-stay appropriateness and documenting findings according to department standards.
Monitor length of stay and ancillary resource use, taking action to support continuous improvement.
Monitor outcome variances, identify their causes, and implement improvement actions.
Seek efficient, cost-effective ways to provide appropriate care and recommend performance improvement opportunities to support cost containment.
Communicate with the Care Management team to facilitate covered-day reimbursement certification or authorization; discuss payer criteria and issues with clinical staff and follow up on payer problems.
Transition patients through the healthcare system according to individual and population needs, coordinating services, health promotion and counseling, disease prevention, health education and screening, and community resource connections.
Participate in special projects and serve on committees as assigned.